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Surgery Best for Degenerative Spondylolisthesis

The recently released results of the second SPORT study showed that patients who selected surgery to treat their lumbar degenerative spondylolisthesis had better outcomes when compared with those who selected nonsurgical treatment. The study included two groups of patients:

Randomized group – 304 patients

In the randomized group, 304 patients were randomly selected to receive either standard posterior decompressive laminectomy (with or without a spinal fusion) or nonsurgical care. Nonsurgical treatments included physical therapy, epidural steroid injections, NSAIDS, and opioids. There was significant crossover from patients in the surgical and nonsurgical groups, with 64% of the surgical group having surgery and 49% of patients assigned to nonsurgical care also having surgery.

Because of the large percentage of patients who crossed over to from non-surgical treatment to surgical and vice-versa, the results of the study are really only meaningful by evaluating how the patients were actually treated, (vs. by their randomized groups).

Observational group – 303 patients

This group was allowed to choose whether to have surgery or receive nonsurgical treatment. 97% of patients who selected surgery went through with the operation, and 25% of the nonsurgical group ultimately chose surgical treatment.

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The study showed that patients in both groups who chose surgery to treat their lumbar degenerative spondylolisthesis and spinal stenosis fared significantly better in terms of pain relief and function at 3 months, 1 year, and 2 years than those who received non-surgical treatment.

The surgery for spondylolisthesis included a decompressive laminectomy with or without an accompanying spinal fusion.

The large cross-over of patients and the favorable outcomes show what doctors and patients already know: those with pain fare best when their care was left to the individual discretion of patient and surgeon.